海嬉潛水店活動報名表

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海嬉潛水店活動報名表

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報名活動 *

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沖繩潛旅

新手到進階水中攝影

墾丁Fun Dive

東北角Fun Dive

乾式防寒衣泳池體驗

Fun Dive 日期

MM

/

DD

/

YYYY

中文姓名 *

Your answer

電子信箱e-mail *

Your answer

出生日期 *

MM

/

DD

/

YYYY

學生性別

男

女

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聯絡電話 *

Your answer

LINE ID *

Your answer

緊急連絡人 *

Your answer

緊急連絡人電話 *

Your answer

潛水級別 *

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開放水域潛水員

進階開放水域潛水員

救援潛水員

名仕潛水員

潛水長

潛水教練

潛水次數

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